Contribution of Atrial Fibrillation to In-Hospital Mortality in Patients With COVID-19

Spinoni, Enrico Guido; Mennuni, Marco; Rognoni, Andrea; Grisafi, Leonardo; Colombo, Crizia; Lio, Veronica; Renda, Giulia; Foglietta, Melissa; Petrilli, Ivan; D’Ardes, Damiano; Sainaghi, Pier Paolo; Aimaretti, Gianluca; Bellan, Mattia; Castello, Luigi Mario; Avanzi, Gian Carlo; Corte, Francesco Della; Krengli, Marco; Pirisi, Mario; Malerba, Mario; Capponi, Andrea; Gallina, Sabina; Pierdomenico, Sante D.; Cipollone, Francesco; Patti, Giuseppe

doi:10.1161/circep.120.009375

Cited by 34 publications

(33 citation statements)

References 4 publications

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“…Of the 783 studies identified from the literature search (216 on Pubmed and 567 on EMBASE), 31 studies were selected according to the inclusion and exclusion criteria and included in the analysis [ 3 , 10 , 11 , 12 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ] ( Figure S1 in Supplementary Materials ), with a total of 187,716 COVID-19 patients. Baseline characteristics of the studies included are reported in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…Thirteen studies were held in Europe [ 10 , 11 , 25 , 29 , 31 , 33 , 37 , 39 , 42 , 43 , 44 , 47 , 50 ], nine in North America [ 3 , 28 , 30 , 32 , 41 , 45 , 46 , 49 , 51 ], four in Asia [ 26 , 34 , 35 , 48 ], and five in other geographical locations, including one multinational study [ 12 , 27 , 36 , 38 , 40 ]. Twenty-five studies were observational retrospective [ 3 , 10 , 12 , 26 , 28 , 30 , 31 , 32 , 34 , 35 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ], four were based on prospective observational analysis of single center cohorts [ 11 , …”

Section: Resultsmentioning

confidence: 99%

“…Of the studies, 14 were included in the analysis for all-cause mortality according to AF status (12 reported in-hospital death [ 3 , 10 , 12 , 25 , 29 , 30 , 37 , 40 , 41 , 42 , 43 , 45 ] and two described 30-day mortality [ 32 , 50 ]). Nine studies included patients with new onset AF [ 10 , 29 , 36 , 37 , 40 , 41 , 42 , 45 , 51 ]. To improve the reliability of our estimates, after careful evaluation of the definitions of AF used and of the data reported, for two studies [ 37 , 51 ], we decided to compute only new onset AF in the main analysis about prevalence.…”

Section: Resultsmentioning

confidence: 99%

“…The evaluation of bias for the two outcomes investigated is reported in Supplementary Materials (Tables S2 and S3, respectively) . Among studies reporting the prevalence of AF, 13 studies were categorized as being at high risk of bias [ 11 , 32 , 33 , 34 , 36 , 37 , 39 , 42 , 44 , 46 , 47 , 48 , 51 ]; incomplete reporting of baseline characteristics was the most common concern. Among the studies reporting all-cause mortality according to AF, two studies were at high risk of bias [ 42 , 50 ].…”

Section: Resultsmentioning

confidence: 99%

“…Subgroup analyses according to the outcome definition are reported in Figure S4 . Twelve studies reported in-hospital death [ 3 , 10 , 12 , 25 , 29 , 30 , 37 , 40 , 41 , 42 , 43 , 45 ] and two reported 30-days mortality [ 32 , 50 ]. Patients with AF showed both higher risk of in-hospital mortality (OR 3.52, 95% CI 2.44–5.10) and 30-days mortality (OR 7.34, 95% CI: 3.11–17.34), with no statistically significant difference between subgroups ( p = 0.12; Figure S4 ).…”

Section: Resultsmentioning

confidence: 99%

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Prevalence and Impact of Atrial Fibrillation in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

Romiti

Corica

Lip

et al. 2021

JCM

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Background: In patients with COVID-19, cardiovascular complications are common and associated with poor prognosis. Among these, an association between atrial fibrillation (AF) and COVID-19 has been described; however, the extent of this relationship is unclear. The aim of this study is to investigate the epidemiology of AF in COVID-19 patients and its impact on all-cause mortality. Methods: A systematic review and meta-analysis were performed and reported according to PRISMA guidelines, and a protocol for this study was registered on PROSPERO (CRD42021227950). PubMed and EMBASE were systematically searched for relevant studies. A random-effects model was used to estimate pooled odds ratios (OR) and 95% confidence intervals (CI). Results: Overall, 31 studies were included in the analysis, with a total number of 187,716 COVID-19 patients. The prevalence of AF was found to be as high as 8% of patients with COVID-19 (95% CI: 6.3–10.2%, 95% prediction intervals (PI): 2.0–27.1%), with a high degree of heterogeneity between studies; a multiple meta-regression model including geographical location, age, hypertension, and diabetes showed that these factors accounted for more than a third of the heterogeneity. AF COVID-19 patients were less likely to be female but more likely older, hypertensive, and with a critical status than those without AF. Patients with AF showed a significant increase in the risk of all-cause mortality (OR: 3.97, 95% CI: 2.76–5.71), with a high degree of heterogeneity. A sensitivity analysis focusing on new-onset AF showed the consistency of these results. Conclusions: Among COVID-19 patients, AF is found in 8% of patients. AF COVID-19 patients are older, more hypertensive, and more likely to have a critical status. In COVID-19 patients, AF is associated with a 4-fold higher risk of death. Further studies are needed to define the best treatment strategies to improve the prognosis of AF COVID-19 patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Prevalence and Impact of Atrial Fibrillation in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

Romiti

Corica

Lip

et al. 2021

JCM

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Pre-existing atrial fibrillation is associated with increased mortality in COVID-19 Patients

Zuin

Rigatelli

Bilato

et al. 2021

J Interv Card Electrophysiol

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Purpose The impacts of pre-existing atrial fibrillation (AF) on COVID-19-associated outcomes are unclear. We conducted a systematic review and meta-analysis to investigate the pooled prevalence of pre-existing AF and its short-term mortality risk in COVID-19 patients. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed in abstracting data and assessing validity. We searched MEDLINE and Scopus to locate all the articles published up to January 31, 2021, reporting data on pre-existing AF among COVID-19 survivors and non-survivors. The pooled prevalence of pre-existing AF was calculated using a random effects model and presenting the related 95% confidence interval (CI), while the mortality risk was estimated using the Mantel-Haenszel random effects models with odds ratio (OR) and related 95% CI. Statistical heterogeneity was measured using the Higgins I 2 statistic. Results Twelve studies, enrolling 15.562 COVID-19 patients (mean age 71.6 years), met the inclusion criteria and were included in the final analysis. The pooled prevalence of pre-existing AF was 11.0% of cases (95% CI: 7.8–15.2%, p < 0.0001) with high heterogeneity ( I 2 = 95.2%). Pre-existing AF was associated with higher risk of short-term death (OR 2.22, 95% CI 1.47–3.36, p < 0.0001), with high heterogeneity ( I 2 = 79.1%). Conclusion Pre-existing AF is present in about 11% of COVID-19 cases but results associated with an increased risk of short-term mortality. Supplementary Information The online version contains supplementary material available at 10.1007/s10840-021-00992-2.

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Atrial fibrillation and COVID-19 in older patients: how disability contributes to shape the risk profile. An analysis of the GeroCovid registry

Fumagalli

Trevisan

Signore³

et al. 2021

Aging Clin Exp Res

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Contribution of Atrial Fibrillation to In-Hospital Mortality in Patients With COVID-19

Cited by 34 publications

References 4 publications

Prevalence and Impact of Atrial Fibrillation in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

Prevalence and Impact of Atrial Fibrillation in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

Pre-existing atrial fibrillation is associated with increased mortality in COVID-19 Patients

Atrial fibrillation and COVID-19 in older patients: how disability contributes to shape the risk profile. An analysis of the GeroCovid registry

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